Cholera outbreak in some communities in North-East Nigeria, 2019: an unmatched case–control study

Abstract

Background Cholera, a diarrheal disease caused by the bacterium Vibrio cholerae, transmitted through fecal contamination of water or food remains an ever-present risk in many countries, especially where water supply, sanitation, food safety, and hygiene are inadequate. A cholera outbreak was reported in Bauchi State, North-eastern Nigeria. We investigated the outbreak to determine the extent and assess risk factors associated with the outbreak. Methods We conducted a descriptive analysis of suspected cholera cases to determine the fatality rate (CFR), attack rate (AR), and trends/patterns of the outbreak. We also conducted a 1:2 unmatched case–control study to assess risk factors amongst 110 confirmed cases and 220 uninfected individuals (controls). We defined a suspected case as any person > 5 years with acute watery diarrhea with/without vomiting; a confirmed case as any suspected case in which there was laboratory isolation of Vibrio cholerae O1 or O139 from the stool while control was any uninfected individual with close contact (same household) with a confirmed case. Children under 5 were not included in the case definition however, samples from this age group were collected where such symptoms had occurred and line-listed separately. Data were collected with an interviewer-administered questionnaire and analyzed using Epi-info and Microsoft excel for frequencies, proportions, bivariate and multivariate analysis at a 95% confidence interval. Results A total of 9725 cases were line-listed with a CFR of 0.3% in the state. Dass LGA had the highest CFR (14.3%) while Bauchi LGA recorded the highest AR of 1,830 cases per 100,000 persons. Factors significantly associated with cholera infection were attending social gatherings (aOR = 2.04, 95% CI = 1.16–3.59) and drinking unsafe water (aOR = 1.74, 95% CI = 1.07–2.83). Conclusion Attending social gatherings and drinking unsafe water were risk factors for cholera infection. Public health actions included chlorination of wells and distribution of water guard (1% chlorine solution) bottles to households and public education on cholera prevention. We recommend the provision of safe drinking water by the government as well as improved sanitary and hygienic conditions for citizens of the state.

Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience

“…Also, the investigated variables on the perceptions of the respondents regarding climate change predisposing factors exhibited significant correlation with the risks of cholera infection. The observations in these regards are not unexpected as they are in agreement with the results of many researchers elsewhere [8,49,51,52]. High levels of health literacy lead to observance of the WASH practices which greatly reduces the chances of the pathogens getting to humans to initiate infection.…”

Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target

“…Delayed detection, reporting, and treatment of cholera cases in regions with high CFRs further support the reported weakened surveillance systems. The consequence is a continuous cross-territorial spread of the disease [21,37].…”

Evaluation of Household Water Treatment Technologies for Cholera Eradication in Sub-Saharan Africa: Epidemiological and Economic Perspectives

“…In 2020, Nigeria the most populous country in sub-Saharan Africa reported an upsurge in cholera cases in October 2020, which transitioned into an epidemic in 2021. According to the Nigeria Centre for Disease Control Surveillance data [5], overall, 93,598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period [6]. In 2021, another significant cholera outbreak occurred in Cameroon, resulting in 27,245 suspected cases and 622 deaths [7].…”